Since childhood, clusters of circles have made me queasy—especially holes. Just thinking of honeycombs or lotus seed pods makes my stomach churn and skin crawl. My affliction has a name: trypophobia. By some estimates, trypophobia affects roughly one in six people. But its rise is sometimes put down to an online meme—an aversion to holes had a moment on the mid-2000s Internet. The condition is no joke, however: it can be debilitating, causing panic attacks and nausea—in extreme cases, people stop driving, miss work or avoid nature for fear of confronting upsetting stimuli.
Researchers first described trypophobia in a 2013 paper and argued that it may be a primitive fear response to venomous animals. Other, more recent theories include that it’s a disease-avoidance instinct that makes us recoil from anything resembling skin lesions or parasites, a form of cortical hyperexcitability where clusters of holes trigger a neural response—a visual equivalent to nails on a chalkboard—or simply a condition that caught on because it was a meme.
Now scientists may finally be closing in on an answer. Geoff Cole—the British scientist who originally pitched the evolutionary fear of venomous animals theory in 2013—recently looked back at the evidence and made a new conclusion. In a 2026 paper, Cole and his co-authors came down in favor of the disease-avoidance theory. Reviewing experiments that tested people’s reactions to triggering images, he concluded that trypophobia is primarily driven by disgust, not fear.
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“Disgust is the mechanism with which we can detect things which carry disease,” says Cole, a researcher at the University of Essex’s Center for Brain Science in England. “It’s clear that the evidence, when you stack it up, is more in favor of the disease-avoidance hypothesis.”
In one experiment, for example, college students were shown trypophobic images, typical fear-inducing pictures—such as those of snakes and spiders—and control images. Participants’ pupils constricted more when they saw the trypophobic images than any of the others—a sign that the parasympathetic nervous system, which is linked to disgust, was activated. Fear, by contrast, is linked to the sympathetic nervous system, which dilates the pupils.
Other research suggests trypophobic people find hole clusters as unpleasant as pictures of skin disease and that people with a history of skin problems may find hole clusters particularly uncomfortable to look at.
That’s not to say fear has no role in trypophobia. Last year a French-led team concluded that while disgust is the “dominant emotion” for trypophobes, “fear is also not negligible.”
To fully settle the question, scientists would need more “hard evidence,” says Christopher DiMattina, a psychology professor at Florida Gulf Coast University. For example, people could be put in an fMRI machine to track their brain activity, then be shown trypophobic and control images. Amygdala activation would suggest fear, while responses in the insular cortex would suggest disgust, he says.
Clinically, phobias are considered anxiety disorders, but some researchers believe that everyone is a little trypophobic. Some people, like me, are bothered by such images but can mostly ignore them. Trypophobia isn’t an official diagnosis—but someone with it could be diagnosed under the term specific phobia if they have severe reactions that interfere with their daily life, according to Kevin Chapman, a clinical psychologist and director of the Kentucky Center for Anxiety and Related Disorders.
“You can technically be phobic of anything,” Chapman says. “There are certain phobias that load more with what we call disgust sensitivity, versus, say, anxiety sensitivity.”
There is little research on effective treatments for trypophobia, and scientists have called for more investment in potential therapies that target disgust. Most people with trypophobia are offered exposure therapy—a form of cognitive-behavioral therapy (CBT) that aims to gradually desensitize someone to the phobic trigger by exposing them to low-level versions of it in controlled settings.
In a handful of published case reports, treatment, including CBT, seems to reduce people’s fear-related symptoms, but it hardly affects their disgust response. That could be because disgust is “generally more resistant to exposure than fear,” according to researchers at Macquarie University in Australia. Just as important as exposure, they argue, is counterconditioning, in which the upsetting stimulus is paired with something positive, such as a good experience or relaxation exercises.
The Australian team put that to the test in a small trial that aimed to alleviate both fear and disgust in nine trypophobic people. The participants underwent a one-session treatment that condensed key CBT principles into a single three-hour session—and was modified to include counterconditioning and other techniques to help them adjust their thinking. A month after the session, most participants reported significant improvements in both disgust and fear.
Chapman says treatment should be tailored to the trypophobic patient based on whether they experience more disgust, fear or anxiety. He recommends a combination of exposure therapy and cognitive restructuring, another CBT-based technique that aims to replace irrational thoughts with neutral, realistic alternatives.
“Particularly when disgust sensitivity is high, you’ve got to really identify what they’re concerned would happen if they encounter it,” he says.
If a person is worried about vomiting, for example, Chapman will work with them on applied muscle tension—a CBT-related technique—to tense up their core so they don’t actually puke. Applied tension is often used to help people with phobias related to needles or blood avoid fainting. Other individuals simply need help learning to tolerate the discomfort of seeing trypophobic images.
“Learning history does matter,” Chapman says.
